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Article

Dehydration in Persons with Dementia: How to Spot it and What to Do About It

By Dr. Philip Sloane

Our bodies are over 50% water, and we need it for blood to flow and for our organs to function.  When we lose too much water from not drinking enough, sweating, or illness, we can get dehydrated. This is rare in children and young adults, however, in older persons dehydration is quite common, especially when the person has Alzheimer’s disease or a related dementia. In fact, most older adults are at least somewhat dehydrated all of the time. This is because many medications cause water loss, and because older people often drink less to avoid frequent trips to the bathroom or accidents. In addition to these common issues, persons with dementia are at even higher dehydration risk because they actually lose the ability to feel thirsty as the illness progresses. This lack of thirst, combined with the decreased ability to ask for a drink or to remember to get a drink for themselves, means that people with dementia can quickly get into dehydration trouble. Why is dehydration a problem? For one thing, people who are dehydrated are more prone to medical problems such as falls, increased confusion, constipation, and bladder or lung infections. Also, because older persons are often mildly dehydrated all the time, any illness carries with it a dehydration risk. In fact, as many as one million older people are hospitalized with dehydration every year. So, it’s important for caregivers to be on the lookout for dehydration, because when caught early, it can often be managed at home without complications. Signs of dehydration include: dry eyes, nose, and/or mouth, urinating less often or in smaller amounts than usual (going 8 or more hours without urination is often a sign of dehydration), a faster heart rate than usual (100 beats per minute or more is considered high), weakness, confusion, sleepiness, and weight loss. The more of these signs the person has, the more likely it is that they are dehydrated. If you think that someone might be dehydrated, what can you do? If the person is very weak, confused, or sleepy– and especially if you can’t get them to drink– you should get medical help right away. But if you think the person might have mild dehydration, and isn’t sick enough to need to see a doctor, encourage them to drink fluids and watch them closely to see if they get better. How much fluid? For most people, aim for between 4 and 6 cups a day. Of course, if it’s unusually hot or the person is sick, they’ll need more. It’s worth mentioning that some people with certain medical conditions have been told by their doctors to limit the amount of fluid they drink. If this is true for the person you care for, ask their doctor what you should do to keep them hydrated. What fluids should you offer? Water is best, but be creative. Studies show people are more likely to drink when offered a variety of things that they like. If the person doesn’t like water, try adding a flavoring such as lemon, or offer juice, milk, smoothies, or low-sodium soup. If the person has trouble swallowing or won’t drink much, try popsicles, gelatins, pudding or sherbet. And keep in mind that many foods are high in water, especially fruits like oranges, peaches, and of course, watermelon. A few common drinks are not highly recommended, because they can be natural diuretics and dry a person out.  Coffee, tea, sodas with caffeine, and alcoholic drinks are all that way.  But, if a cup of coffee helps get the person going, or a glass of wine before dinner stimulates their appetite, offer it. Just be sure to also offer plenty of water and other non-drying fluids. If the person you care for is reluctant to drink or flat out refuses fluids, here are a few tips you might try: •    Offer drinks regularly throughout the day -- not only with meals and before bed, but also before or after routines like bathing. •    Think about how you can make drinking fun and social—perhaps have afternoon tea or a nonalcoholic happy hour together. •    Be sure that drinks are always within reach. •    Try different containers, and then use whichever works best. You might try sports bottles, sippy cups, straws or small bottled waters.  For persons with advanced dementia, there’s even a type of syringe that you can use to help get fluid into the back of their mouth, where the swallowing reflex will often take over.   •    Remember to aim for 4 to 6 cups of fluid a day. You might want to keep track of the amount with a drink diary. •    Do the best you can– encourage but don’t force. •    Keep in mind that the person will need more fluid in hot weather, or if they have fever, vomiting or diarrhea. Following these hydration tips can help keep the person you care for healthier and out of the emergency room and hospital. Dr. Philip Sloane is the Elizabeth and Oscar Goodwin Distinguished Professor of Family Medicine and Geriatrics at the University of North Carolina at Chapel Hill. A nationally recognized researcher on Alzheimer’s disease, he is recipient of the prestigious Pioneer Award from the Alzheimer’s Association. His most recent book, The Alzheimer’s Medical Advisor, was written to help family caregivers address these issues. Released in July, it is available through major retailers like Barnes & Noble and Amazon, and from the Sunrise River Press website.

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